Tonsil enucleator



March 6, 1951 s. M. COTTRELL- TONSIL ENUCLEATOR Filed July 7., 1950INVENTOR.

SAMUEL M. COTTRELL BY ATTORNEY fiateiated Mar. 6, I I a v r an mb n.

I wi r Obieqt; d? an m v 'i t6 d cuttin d n; blaflde.

trated comprises a relatively narrow shank or base portion Interminating in a slightly enlarged and substantially oval-shaped distalportion provided with a similarly oval-shaped aperture l2. The majoraxis of the aperture I2 is transversely disposed with respect to thelongitudinal axis of the shank l and the tonsil to be severed isintended to be received within this aperture. Preferably the upper,surface of the shank is horizontally disposed and the lower surface isgradually tapered, enlarging slightly from front to rear and including adepending handle portion l3 which may, if desired, be formed integrallytherewith. As will be more readily apparent from an examination of Fig.l of the drawing, the handle I3 is of the pistol grip type, the forwardedge thereof including aplurality of arouate depressions complementarilyconformed with respect to the inner surfaces of the fingers of theoperator.

' Convenience of grasping in either hand is thus provided, assuringperfect control of the instrument. It has been found advantageous toincline the handle portion 13 at a slight rearward angle from theperpendicular, thereby materially assisting in determining the positionat which the instrument will be inserted into the oral cavity of thepatient. The length of the shank portion I0 is such that the distalextremity of the instrument will conveniently reach to the Walls of thepatients throat with the handle portion spaced adequately from thepatients lips to permit visual observation by the surgeon of theoperative area. The proximal extremity of the shank Ill, beyond andincluding the handle portion I3, is provided with an enlarged portion |4including'vertically disposed side walls I5, a transverse 'end wall l6and a top wall I! forming a recessed portion within which the proximalextremities of the cutting blade and the upper blade or top shankportion are received, as will be described more fully hereinafter. Thecutting blade l8 is relatively thin and narrow, substantiallycorresponding in width to the width of the shank portion of theinstrument, and terminating in an enlarged and oval-shaped distalportion. I 9 provided with an oval-shaped aperture 20 subs'tantiallyidentical in size and shape to the aperture l2. A relatively short slot2|, communicat ing with the aperture 20, is formed in the cutting bladealong the longitudinal axis thereof and the blade is further providedwith a cut-away portion 22, spaced slightly from the slot 2|, to assistin the handling and sterilization thereof.

) The opposed extremity of the cutting blade l8 terminates in astem-like portionor shaft 23 which may be formed integrally therewith'orotherwise rigidly secured thereto and which is externally screw-threadedas indicated at 24 for engagement with'a complementarily internallyscrew-threaded wing-nut 25 or the like.' To prevent inadvertentdisengagement of the wing-nut from the shaft 23, this shaft is formedwith a reduced threaded extremity 26 and a lock-nut 21, preferablyprovided with an appropriately knurled peripheral surface for the moreconvenient manipulation thereof, is engaged therewith.

As is more particularly illustrated in Fig. of the. drawing, the uppersurface of the cutting blade I8 is provided with an upstanding lug 28,

positioned adjacent the rear wall of the cut-away.

portion 22. Vertically disposed grooves or recessed portions 29 and 30areprovided in the side walls of the lug 28 which provide supportingmeans for trigger mechanism to be described more fully hereinafter.

Preferably the upper surface of the bottom wall of the recess formed inthe enlarged portion l4 of the shank is provided with an arcuate groove3| intended to receive the threaded shaft 23 and assist in guiding themovement of the cutting blade. To further support the trigger mechanism,laterally disposed ears 32 are provided upon the side edges of thecutting blade. These ears are preferably provided with an arouate rearedge to eliminate aneedlessly sharp or projecting corner and are locatedin substantial alignment with the lug 28 and immediately to the rear ofthe opposed grooves 29 and 30.

It. will be understood that the cutting blade |8 rests upon the flatupper surface of the shank or base portion l0 and an upper blade 33 isprovided, substantially complementary in configuration to the shank ID,the cutting blade being mounted for reciprocal movement therebetween.The upper blade also terminates in an enlarged and slightly oval-shapeddistal portion 34 provided with a similarly oval-shaped aperture 35.Preferably the lower surface of the blade 33 is horizontally disposedand the upper surface is gradually tapered, enlarging slightly fromfront to rear and provided with a recessed portion 36 extending from therear or proximal ext'remity thereof intended for the accommodation ofthe threaded shaft 23. The upper blade is further provided with alongitudinally cut-away portion 31, through which the lug 28 on thecutting blade projects, and with a second longitudinally disposedcut-away portion 38, spaced slightly from the cut-away portion 31, toassist in the handling and sterilization thereof. The proximal extremityof the upper blade 33, to-" gether with the rear extremity of thecutting blade, fit snugly within the recess formed in the enlargedportion M of the shank or base In and suitable means is provided formaintaining the distal extremities of the shank l0 and upper blade 33,with the cutting blade l8 therebetween, inappropriately associatedrelationship. A preferred embodiment of suchmeans has been illustratedas diametrically opposed, downwardly depending ears 39, located uponthemajor axis of the enlarged portion 34 of the upper blade andpreferably formed integrally therewith. The free extremities 40 of thesecars are turned inwardly and, as is more fully .disclosed in Fig. 6 ofthe drawing, the enlarged distal extremities II and L9 of the shank l0and cutting blade l8, respectively, are thus maintained in properassociated relationship. To prevent any possibility of undue freedom ofmovement of the cutting blade between the upper and lower shank members,a threaded aperture 4| is provided in the upper blade 33 and a similarlythreaded aperture 42 positioned in vertical alignment with the aperture4| is provided in the shank H]. A locking screw 43, having anappropriately knurled head for convenience of manipulation, engageswithin the aligned apertures 4| and 42 and insures the snug retention ofthe cutting blade between the opposed horizontal surfaces of the upperblade 33 and shank ID. If desired, a resilient locking plate 44 ma beprovided upon the lower surface of the shank I0, positioned forfrictional engagement with the knurled head of the screw .43 to preventinadvertent loosening thereof. It will be observed that the screw 43projects through the slot 2| in the cutting blade I8 and does notinterfere with the necessary freedom of movement of such blade.

, Any desired mechanism may be provided fo imparting appropriatemovement to the cutting blade IS. The preferred form thereof comprises atrigger member 45 including a downwardly depending and forwardly curvedfinger engaging portion 66 provided with a serrated surface 41. Forconvenience of assembly the trigger is formed in complementary parts andincludes a horizontally disposed wall surface 48 located above thefinger engaging portion 45. A vertically disposed end wall 49 isprovided on the trigger member and the inner surface of this wallincludes, a vertically disposed rib 58 intended for engage ment withinthe groove 29 of the lug 28 on'the cutting blade. The free extremity ofthe wall surface 48 has an opposed end wall member .51 mountedthereupon, complementary in configuration to the wall 49. As will bemore readily apparent from an examination of Fig. 9 of the drawing, thewall member includes a reduced lower extremity 52 receivable within agroove 53 provided in the adjacent side of the trigger member. The innervertical surface of the wall memprises a pawl 62 pivotally mounted asindicated at 63 upon an ear or the like 64 formed integrally with orotherwise secured to the upper surface of the top wall I! of theenlargedportion M of the shank l0. One extremity of this pawl includes adepending finger 65 which projects through an aperture 86 formed in thetop wall I! and engages with the serrations or teeth of a ratchet 61formed in the upper surface of the threaded shaft 28. The oppositeextremity of the pawl, which may be conveniently manufactured fromspring steel,.or the like, comprises a resilient portion 68 of reducedthickness which engages against the upper surface of the wall I! at apoint remote from the pivotal mounting of the pawl 62. Withthearrangement of parts thus described, it will be readily understood thatas the wing-nut is tightened the finger 85 of the pawl progressivelyengages with the teeth of the her 51 is complementary to the Wall 49,including ture 5 and the wall 49 is provided with a horizontallydisposed transverse aperture 58 positioned in accurate alignment withthe threaded aperture 51. A locking screw 59 having a knurled head 60 isprovided for maintaining the trigger parts in assembled relationship.This screw 59 is of sufiicient length to project through the aperture 58in the end wall 49 and an aperture 61 provided in alignment therewith inthe lug 28 and engage within the threaded aperture 51 in the detachablewall portion or member 5|.

The operative technique in handling the tonsil enucleator, thusdescribed is particularl simple. With the cutting blade in the positionillustrated in Fig. 2 of the drawing, the instrument is grasped inthehand of the surgeon and the distalextremity is positioned below andbehind the tonsil to be removed. The operator then gently pushes thetonsil through the aligned apertures in the distal extremities of theupper blade, cutting blade, and shank, using the index finger of theopposite hand. Pressure is then exerted upon the trigger, utilizing theindex finger of the hand grasping the instrument for this purpose, andthe cutting blade I8 of the device is raised to the position illustratedin Fig. 3 of the drawing Where the tonsil is firmly caught by theforward edge 28' of the aperture 20. It will be observed that the edge20 is not a sharpened cutting edge or surface, but is a verticallydisposed and dull edge having the full thickness of th cutting blade.The wing-nut 25 is then gently threaded to the position illustrated indotted lines in this figure of the drawing, suitable means beingprovided to temporarily retain the wing-nut in this adjusted position.

A preferred embodiment of such means comratchet, effectively preventingthe return of the cutting blade to normal or inoperative position.

Tightening of the wing-nut 25 is then continued, the procedure being agentle and gradual one, until the cutting blade is lifted to theposition illustrated in Fig. 4 of the drawing, where the forward edge28' has passed beyond the confines of the apertures l2 and 35, at whichtime the actual enucleation will have been completed. This technique isespecially designed so that the cutting blade moves way from both theanterior and posterior pillars of the tonsil thereby reducing to anabsolute minimum the possibility of damaging these structures.

It has been found in practice that the use of a. dull cutting blade, asdistinctly opposed to a sharp blade, tends to seal off the small bloodvessels as it passes slowly behind the tonsil. This is consideredparticularly important, where the surgeon takes into consideration theblood clotting time of the patient. If an identical or evensubstantially similar length of time is taken for the completion of theseverance, where the cutting blade is moved from the grasping position,illustrated in Fig. 3 of the drawing, to the final position disclosed inFig.4, the operation can frequently be completed without loss of bloodby the patient. r

The operative technique thus described is as simple as the device itselfwhich includes no delicate or complicated parts which may get out oforder or require unduly careful handling. The instrument can be readilyand quickly assembled or disassembled and presents no problems in thesterilization thereof. It is particularly light in weight, may beconveniently grasped in either hand and function with a degree ofefficiency heretofore unknown in the field of surgery with which we arehere concerned.

It will be obvious to those skilled in this profession that variouschanges may be made in the instrument without departing from the spiritand scope of the invention and, therefore, the invention is notconsidered limited by that which is illustrated in the drawing anddescribed in the specification, but only as indicated in the appendedclaims.

What is claimed is:

1. A tonsil enucleator comprising an elongated shank provided with anenlarged distal extremity having an oval-shaped aperture therein, anenlarged portion on the opposite extremity of said shank provided with alongitudinally disposed recess, a pistol grip handle depending from saidshank adjacent said opposite extremity, a cutting blade supported uponsaid shank and movable longitudinally thereof, said cutting bladeincludareas-as ing: an enlarged distal extremity provided with an"oval-Shaped aperture substantially identical in size to the aperture insaid shank, the peripheral wall of the aperture in the cutting bladebeing perpendicularly disposed with respect to the longitudinal axis ofsaid blade, a screwthreaded shaft on the opposite extremity of saidcutting blade receivable within the recess in" said shank'and projectingthrough the end wall thereof, threaded means engaging the projectingextremity of said shaft and operable to move said cutting blade in adirection toward said handle, an upper blade complementary inconfiguration to said shank, an enlarged distal extremity on said upperblade having an oval-shaped aperture therein substantially identicalinsize to the aperture in said shank and coinciding therewith, theopposite extremity of said upper blade being receivable Within therecess ili- Said Shank, diametrically opposed ears formed integrally on"the enlarged portion of said upper blade and depending therefrom,inwardly directed extremities on said ears for engaging beneath saidshank and maintaining said shank and upper blade in fixed relationshipwith the cutting blade movable therebetwcen, a longitudinallydisposedslot in said upper blade located adjacent the proximal extremitythereof, an upstanding lug onsaid cutting blade projecting through theslot in said upper blade, trigger means mounted upon said lug anddepending beneath said shank for moving said cutting blade in adirectiontoward said handle, ratchet teeth formed on the upper surfaceof said threaded shaft, anda resilient pawl pivotally mounted upon theenlargedportion of said shank and having a depending fin ger projectingthrough an aperture in said enlarged portion and engaging said ratchetto maintain said cutting blade in adjusted position'.

2'. A tonsil enucleator comprising an elongated shank provided with anenlarged distal extrenrity having an oval-shaped aperture therein, anenlarged portion On the opposite extremity of said shank provided with alongitudinally disposed recess, a' pistol-grip handle depending fromsaid shank adjacent said opposite extrern-- ity, a cutting bladesupported upon said shank and movable longitudinally thereof, saidcutting blade including an enlarged distal extremity provided with anoval-shaped aperture substantially identical in size to the aperture insaid shank, the peripheral wall of the ape'rtureinthe cutting bladebeing perpendicularly disposed with respect to the longitudinal axis ofsaid blade; 2. screw-threaded shaft on the oppositeextremit'y'of saidblade receivable Within the reoess in said shank and projecting throughthe end wall thereof, threaded means engaging the projecting extremityof said shaft and operable to move said cutting blade in a directiontoward said handle, an upper blade complementary in configuration tosaid shank, an enlarged distal extremity on said upper blade providedwith an oval-shaped aperture substantially identical in size to theaperture in said shank and coinciding therewith, the opposite extremityof the upper blade being receivable within the recess in said shank,securing means for maintaining. said upper blade and shank in fixedrelationship with the cutting blade movable therebetween, alongitudinally disposed slot in said upper bladelocated adjacent theproximal extremity thereof,

an upstanding lug on said cutting blade projecting through the slot insaidupperblade, trigger means mounted upon said lug'and depending be;heath said shank for moving said cutting blade in a direction towardsaid handle, and pawl and ratchet means for maintaining said cuttingblade in ad usted position when moved thereto by said trigger means.

3. A tonsil enucleator comprising an elongated shank provided with anenlarged distal extrem ity having an oval-shaped aperture therein, themajor axis of said aperture being disposed transversely with respect tothe longitudinal axis of said shank, an enlarged portion on the oppositeextremity of said shank provided with a longitudinally disposed recessincluding top,- side and end Walls, an angularly inclined pistol griphandle depending from said shank adjacent said opposite extremity, acutting blade sup" ported upon said shank and movable longitudi-'i nallythereof, said cutting blade being of corn plementary configuration tosaid shank, an errlarged distal extremity on said cutting blade providedwith an oval-shaped aperture substan'-' tially identical in size to theaperture in saidshank, the peripheral wall of the aperture in thecutting blade being perpendicularly disposed with respect to thelongitudinal axis of said blade, a screw-threaded shaft on the oppositeextremity of said blade receivable within the re-" cess in said shankand projecting through the end wall thereof, threaded means engaging theprojecting extremity of said shaft and operable to move the cuttingblade in a direction towardsaid handle, an upper blade complementary inconfiguration to said shank, an enlarged distal= extremity on said upperblade provided with an oval-shaped aperture substantially identical insize'to the aperture in said shank and coincid ing therewith, theopposite extremity of the" upper blade being receivable within therecess in the enlarged portion of said shank, securingmeans formaintaining said upper blade and shank in fixed relationship with thecutting blade movable therebetween, a longitudinally disposed slot insaid upper blade located adja-* cent the proximal extremity thereof, anup standing lug in said cutting blade projecting through the slot in theupper blade, trigger means mounted upon said lug and depending beneathsaid shank for moving said cutting blade in a direction toward saidhandle, and means for maintaining said cutting blade in ad-- justedposition when moved thereto by said trigger means.

4. A tonsil enucleator comprising an elongated shank provided with anenlarged distal extrem ity having an oval-shaped aperture therein; anenlarged portion on the opposite extremity of said shank provided with alongitudinally dis posed recess, a pistol-grip handle depending fromsaid shank adjacent said opposite extrem ity, a cutting bladecomplementary in configu ration to the shank supported upon saidshankand movable longitudinally thereupon, an en-' larged distalextremity on said cutting blade- '2 provided with an oval-shapedaperture substantially identical in: size to the aperture in said shank,the peripheral wall of the aperture in the cutting blade beingperpendicularly disposedwith respect to the longitudinal axis ofsaidblade, a screw-threaded shaft on the opposite extremity of saidblade receivable within therecessin said shank and projecting throughthe end wall thereof, threaded means engagingthe projecting extremity ofsaid shaft and operableto movesaid cutting blade in a direction towardsaid handle, an upper blade complementary in configuration to saidshank, an enlarged distal extremity on said upper blade provided with anoval-shaped aperture substantially identical in size to the aperture inthe shank and coinciding therewith, the opposite extremity of the upperblade being receivable within the recess in said shank, securing meansfor maintaining said upper blade and shank in fixed position with thecutting blade movable therebetween, a longitudinally disposed slot insaid upper blade located adjacent the proximal extremity thereof, anupstanding lug on the cutting blade projecting through the slot in saidupper blade, and trigger means mounted upon said lug and dependingbeneath said shank for moving the cutting blade in a direction towardsaid handle.

5. A tonsil enucleator comprising an elongated shank provided with alongitudinally disposed recess, a pistol-grip'handle depending from saidshank adjacent said opposite extremity, a cutting blade complementary inconfiguration to the shank supported upon said shank and movablelongitudinally thereof, an enlarged distal extremity on said cuttingblade provided with an oval-shaped aperture substantially identical insize to the aperture in said shank, the peripheral wall of the aperturein the cutting blade being perpendicularly disposed with respect to thelongitudinal axis of said blade, a screw-threaded shaft on the oppositeextremity of said cutting blade receivable within the recess in saidshank and projecting through the end wall thereof, threaded meansengaging the projecting extremity of said shaft and operable to movesaid cutting blade in a direction toward said handle, an upper bladecomplementary in configuration to said shank, an enlarged distalextremity on said upper blade provided with an oval-shaped aperturesubstantially identical in size to the aperture in said shank andcoinciding therewith, the opposite extremity of said upper blade beingreceivable within the aperture in said shank, securing means formaintaining said upper blade and shank in fixed relationship with thecutting blade movable therebetween, trigger means for moving said.cutting blade in a direction toward said handle, and pawl and ratchetmeans for maintaining said cutting blade in adjusted position when movedthereto by said trigger means.

6. A tonsil enucleator comprising an elongated shank provided with anenlarged distal extremity having an aperture therein,,an enlargedportion on the opposite extremity of said shank provided with alongitudinally disposed recess, a pistolshank handle depending from saidshank adjacent said opposite extremity, a cutting blade movablelongitudinally upon said shank and generally complementary thereto inperipheral configuration, an enlarged distal extremity on said cuttingblade provided with an aperture substantially identical in size to theaperture in said shank, the peripheral wall of the aperture in saidcutting blade .being perpendicularly disposed with respect to thelongitudinal axis of said blade, a screw-threaded shaft on the oppositeextremity of said cutting blade receivable within the recess in theshank and projecting through the end wall thereof, threaded meansengaging the projecting extremity of said shaft and operable to movesaid cutting blade in a direction toward said handle, an upper bladegenerally complementary in peripheral configuration to said shank, anenlarged distal extremity on said upper blade provided with an aperturesubstantially identical in size to the aperture in said shank andcoinciding therewith, the opposite extremity of said upper blade beingreceivable within the aperture in the shank, means for maintaining saidupper blade and shank in fixed relationship with the cutting blademovable therebetween, trigger means for moving the cutting blade in adirection toward said handle, and means for maintaining said cuttingblade in adjusted position when moved thereto by said trigger means.

'7. In a tonsil enucleator as set forth in claim 3, spaced side walls onsaid trigger means, one of said side Walls being separable, verticallydisposed ribs on the opposed inner surfaces of said side walls, saidribs being receivable within opposed grooves provided in the side wallsof the upstanding lug, and means for maintaining said trigger mountedupon said lug, said side walls being grooved beneath said ribs toembrace said shank, cutting blade, and upper blade.

SAMUEL M. COTTRELL.

No references cited

